Self-Care Assessment Worksheet - www4

Self-Care Checklist
This assessment tool provides an overview of effective strategies that you
can do to maintain your resilience and promote personal sustainability. After
completing the full assessment, choose one item from each area that you will
actively work on to take good care of yourself.
Using the scale below, rate the following areas in terms of frequency:
5 = Frequently
4 = Occasionally
3 = Rarely
2 = Never
1 = It never occurred to me
Physical Self-Care
___ Eat regularly (e.g. breakfast, lunch and dinner)
___ Eat healthy
___ Exercise
___ Get regular medical care for prevention
___ Get medical care when needed
___ Take time off when needed
___ Get massages
___ Dance, swim, walk, run, play sports, sing, or do some other physical
activity that is fun
___ Take time to be sexual—with yourself, with a partner
___ Get enough sleep
___ Wear clothes you like
___ Take vacations
___ Take day trips or mini-vacations
___ Make time away from telephones
___ Other:
Psychological Self-Care
___ Make time for self-reflection
___ Have your own personal counselor or coach if you need one
___ Write in a journal
___ Read literature that is unrelated to work
___ Do something at which you are not expert or in charge
___ Decrease stress in your life

___ Let others know different aspects of you
___ Notice your inner experience—listen to your thoughts, judgments,
beliefs, attitudes, and feelings
___ Engage your intelligence in a new area, e.g. go to an art museum, history
exhibit, sports event, auction, theater performance
___ Practice receiving from others
___ Be curious
___ Say “no” to extra responsibilities sometimes
___ Other:
Emotional Self-Care
___ Spend time with others whose company you enjoy
___ Stay in contact with important people in your life
___ Give yourself affirmations, praise yourself
___ Love yourself
___ Re-read favorite books, re-view favorite movies
___ Identify comforting activities, objects, people, relationships, places and
seek them out
___ Allow yourself to cry
___ Find things that make you laugh
___ Express your outrage in social action, letters and donations, marches,
protests
___ Play with children
___ Other:
Spiritual Self-Care
___ Make time for reflection
___ Spend time with nature
___ Find a spiritual connection or community
___ Be open to inspiration
___ Cherish your optimism and hope
___ Be aware of nonmaterial aspects of life
___ Try at times not to be in charge or the expert
___ Be open to not knowing
___ Identify what is meaningful to you and notice its place in your life
___ Meditate
___ Pray
___ Sing

___ Spend time with children
___ Have experiences of awe
___ Contribute to causes in which you believe
___ Read inspirational literature (talks, music, etc.)
___ Other:
Workplace or Professional Self-Care
___ Take a break during the workday (e.g. lunch)
___ Take time to chat with co-workers
___ Make quiet time to complete tasks
___ Identify projects or tasks that are exciting and rewarding
___ Set limits with your clients and colleagues
___ Balance your workload so that no one day or part of a day is “too much”
___ Arrange your work space so it is comfortable and comforting
___ Get regular supervision or consultation
___ Negotiate for your needs
___ Have a peer support group
___ Develop or explore other areas of professional interest
___ Other:
Balance
___ Strive for balance within your work-life and workday
___ Strive for balance among work, family, relationships, play and rest
Adapted from: Saakvitne, K.W. and Pearlman,L.A. (1996). Transforming the
Pain: A Workbook on Vicarious Traumatization. New York: Norton.